Imposes certain duties, transparency, and accountability from pharmacy benefits managers and pharmacy benefits management services.

Rhode Island Pharmacy Benefits Manager Accountability Bill

This bill would place new rules and requirements on pharmacy benefits managers (PBMs) — the companies that act as middlemen between insurance plans, drug manufacturers, and pharmacies to manage prescription drug benefits. PBMs play a major behind-the-scenes role in determining which drugs are covered, how much they cost, and which pharmacies patients can use. The bill would require PBMs to operate more transparently and be held accountable for how they handle prescription drug benefits on behalf of health insurance plans.

Specifically, the bill would impose duties related to transparency and fair practices, meaning PBMs would need to be more open about how they make decisions, set prices, and compensate pharmacies. This could include requirements around disclosing fees, rebates they receive from drug manufacturers, and how they reimburse local and independent pharmacies compared to pharmacies they may own or have financial ties to.

Who would this affect? Rhode Island residents who have prescription drug coverage through their employer or insurance plan could potentially benefit from lower costs and greater access to the pharmacies of their choice. Independent and local pharmacies could benefit from fairer payment practices. Insurance companies and PBMs would face new compliance requirements.

The bill was introduced in the Senate and referred to the Senate Health and Human Services Committee, which has recommended holding it for further study. This means it has not yet advanced and lawmakers are still evaluating its potential impact.